Self Drive Vehicle Request Form

Application for OR Variation to Office Max Account

(Original to be forwarded to: the Credit Card Administrator, Office of Financial Services)

PLEASE TICK: New Application Change to Existing
Department/Office: ______/ Delivery Address .:______
Contact Person: ______
Major Account (Operating):______/ Phone: ______
Details of People Placing Orders
Name:______Extension:______
Email Address:______
Name:______Extension:______
Email Address:______
Name:______Extension:______
Email Address:______
Details of People Approving Orders (must have minimum $10,000 delegation)
Name:______Extension:______
Email Address:______
Name:______Extension:______
Email Address:______
People to be deleted from this account
Name:______Extension:______
Email Address:______
Name:______Extension:______
Email Address:______
Authorisation
Signature:______Date:______
(Head of Department/Office/General Manager)
Financial Services Use Only
Delegation Checked:______Sent to Office Max:______
(Date) (Date)
Queries – Please contact Credit Card Administration on extension 1680

H:\Purchasing Services\PROCUREM\OFFICEMAX\Office Max Account Application.doc February 2010